Neural Event Process

ABSTRACT

A neural event process, including receiving a neural response signal, decomposing the signal using at least one wavelet, differentiating phase data of the wavelets and the response signal to determine maxima and minima of the phase data and the signal, and processing the maxima and minima to determine peaks representing neural events.

FIELD

The present invention relates to a neural event process and a system forperforming the process. The process may advantageously be used toextract data representing a response produced by a patient's auditory orvestibular system.

BACKGROUND

Systems have been developed to obtain an auditory evoked response (AER)or brainstem auditory evoked response (BAER) for a patient representingactivity of the patient's auditory system. The AER is an electricalbrain wave or neural response obtained from electrodes placed on thepatient in response to a stimulus, normally a sound. Depending of thelatency of the response and the placement of the electrodes, differentclasses or types of AERs can be obtained. Those with the shortestlatency are generated by the inner ear and the auditory nerve, and arereferred to as electrocochleography responses. The next responsereflects activity within the auditory brainstem and is referred to as anauditory brainstem response (ABR). Further detail is provided in Hall,James W, III; Handbook of Auditory Evoked Responses; Allyn and Bacon;Needham Heights, Mass., 1992.

Electrocochleography (“ECOG” or “ECochG”) systems are currently used toperform diagnoses of the cochlea and vestibular apparatus. In the caseof the vestibular system, recently analysis for this specific part ofthe ear has been referred to as electrovestibulography (EVestG), being aspecific sub-class of ECOG. The systems are used to produce a patientneural response which involves placing a recording electrode as close aspractical to a patient's cochlea. An acoustic transducer, eg anearphone, is used to provide an auditory stimulus to evoke the response.For EVestG the patient is however tilted, in different directions, toevoke a specific response from the vestibular apparatus. It is notnecessary to also use an auditory stimulus for EVestG. An ECOG signalrepresenting the neural response is used to determine an Sp/Ap ratiothat can be used for the diagnosis of a number of conditions,particularly Meniere's disease. The first wave, normally labelled N1, ofthe response signal is examined to determine the summating potential(Sp), the action potential (Ap) and the second summating potential(Sp2), as shown in FIG. 1. The response is only of the order of a few μVand is received with considerable unwanted noise making it difficult todetermine and isolate.

For example, the ECOG signal is normally assessed by obtaining multiplesamples from a patient in response to acoustic stimuli, and thenobtaining an average Sp/Ap ratio for diagnosis. This process, however,is neither very sensitive nor specific, as a patient can have Meniere'sdisease and a normal ECOG, and alternatively the patient could also havean abnormal ECOG, but not have Meniere's disease. Accordingly, analternative process (“the Franz process”) has been developed byProfessor Burkhard Franz, as described in International PatentPublication WO 02/47547, which seeks to analyse directly the vestibularresponse, rather than the cochlea response, as Meniere's disease is apathology of the vestibular system. The Franz process uses an ECOGsystem to record the response obtained from a patient asked to tilttheir head either forward, backward, contralaterally or ipsilaterally.The process seeks to identify a periodic signal in the response which isbelieved to come from either the semi-circular canals (SCCs) or theotolith organs at predominantly 23 Hz, but also at 11.5 Hz and 46 Hz.This analysis is done by averaging the ECOG response over a number ofintervals at the frequency of interest, eg 1/23 Hz at repeatedintervals.

There are, however, a number of difficulties with the Franz process.Firstly, the process is not considered to be reliable for all patients,and particularly for inhibitory head tilts and especially forinvoluntary head tilts. The process also cannot be easily adopted by anaudiologist without significant training. Also, more significantly, ithas been found that the frequencies of interest, 11.5, 23 and 46 Hz, donot have characteristic signals that can be reliably located once thebackground signal for ambient noise has been removed. This indicatesthat these frequency components of the ECOG response are primarilyinduced by background noise and/or muscle (premotor and/or motor)activity, and any response from the SCCs and otolith organs is extremelydifficult to detect or isolate at these frequencies.

Similar problems exist with determining and analysing other AERs, suchas the ABR.

Accordingly, it is desired to address the above, or provide at least auseful alternative.

SUMMARY

In accordance with the present invention there is provided a neuralevent process, including:

-   -   receiving a neural response signal;    -   decomposing said signal using at least one wavelet;    -   differentiating phase data of said wavelets and said response        signal to determine maxima and minima of said phase data and        said signal; and    -   processing said maxima and minima to determine peaks        representing neural events.

The present invention also provides a neural event process, including:

-   -   receiving a neural response signal produced by an ECOG system;    -   decomposing said signal into at least one wavelet representing a        centre frequency having a low frequency in the spectrum of said        signal, said wavelet having a small bandwidth factor;    -   differentiating phase data of said wavelet and said response        signal to determine maxima and minima of said phase data and        said signal; and    -   processing said maxima and minima to determine an Sp/Ap ratio.

The present invention also provides an auditory brain stem response(ABR) process, including:

-   -   receiving an ABR signal produced by an ABR system;    -   decomposing said signal into at least one wavelet representing a        centre frequency having a low frequency in the spectrum of said        signal, said wavelet having a small bandwidth factor;    -   differentiating phase data of said wavelet and said response        signal to determine maxima and minima of said phase data and        said signal; and    -   processing said maxima and minima to determine Sp and Ap data.

The present invention also provides a system for performing the process.

The present invention also provides a computer readable medium havingcomputer program code for use in performing the process.

The present invention also provides a neural response system, including:

-   -   electrodes for connecting to a person to obtain a neural        response signal;    -   an amplifier for receiving and producing a sampled form of said        signal for processing; and    -   an analysis module for decomposing said signal using at least        one wavelet, differentiating phase data of said wavelets and        said response signal to determine maxima and minima of said        phase data and said signal, and processing said maxima and        minima to determine peaks representing neural events.

The present invention also provides a neural response system, including:

-   -   electrodes for connecting to a person to obtain a neural        response signal;    -   an amplifier for receiving and producing a sampled form of said        signal for processing; and    -   an analysis module for processing said signal to generate a TAP        marker to indicate whether a person has a disorder.

The present invention also provides a neural response system, including:

-   -   electrodes for connecting to a person to obtain a neural        response signal;    -   an amplifier for receiving and producing a sampled form of said        signal for processing; and    -   an analysis module for processing said signal to generate plot        of time and frequency data for peaks in the 70 to 300 Hz range        to display activity of components of a person's auditory system        and mark any disorder.

The present invention also provides a neural response process, includingprocessing a response signal obtained from a person to generate a TAPmarker to indicate whether said person has a disorder.

The present invention also provides a neural response process, includingprocessing a response signal obtained from a person signal to generateplot of time and frequency data for peaks in the 70 to 300 Hz range todisplay activity of components of a person's auditory system and markany disorder.

BRIEF DESCRIPTION OF THE DRAWINGS

Preferred embodiments of the present invention are hereinafterdescribed, by way of example only, with reference to the accompanyingdrawings, wherein:

FIG. 1 is a representation of Sp, Ap and Sp2 points related to the firstwave of a generalized ECOG response signal from an ECOG system anddefines the summating potentials Sp and Sp2 and the action potential Ap;

FIG. 2 is a schematic diagram of a preferred embodiment of an ECOGsystem connected to a patient;

FIG. 3 is a response signal recorded by the system;

FIG. 4 is a flow diagram of a neural event process performed by the ECOGsystem;

FIGS. 5 to 10 are Sp/Ap plots produced by the neural event process;

FIG. 11 is a display of Sp/Ap plots produced using a high pass filter bythe ECOG system;

FIG. 12 is a display of Sp/Ap plots produced by the ECOG system byincluding DC offsets of the stimulus response;

FIG. 13 is a flow diagram of a neural event process performed by apreferred embodiment of an ABR system connected to a patient;

FIG. 14 is a display produced by the ABR system of detected ABR neuralevents;

FIG. 15 is a diagram of different ABR components;

FIG. 16 is a display of Sp/Ap plots for a Parkinson's patient producedby the ECOG system;

FIG. 17 is a display of Sp/Ap plots produced for a patient sufferingdepression by the system;

FIGS. 18 and 19 are displays of Sp/Ap plots produced for a Meniere'spatient by the system;

FIGS. 20 to 24 are displays of TAP measurement markers produced by thesystem for a number of patients;

FIG. 25 is a diagram of averaged wavelet coefficients against frequencygenerated by the system; and

FIG. 26 is a display of HF/LF ratio data markers produced for a numberof different patients by the system.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

An ECOG system 2, as shown in FIG. 2, is used to obtain Sp/Ap plots, asshown in FIGS. 5 to 10, from a patient who is subjected to a singlestimulus, eg an involuntary head tilt. The Sp/Ap plots are generatedfrom the ECOG signal produced in response to the stimulus. The ECOGsignal is obtained from electrodes 10, 12 and 14 electrically connectedto an amplifier circuit 22 of a computer system 20 of the ECOG system 2.A first electrode 10 (eg a ECochG Electrode produced by Bio-LogicSystems Corp (http://www.blsc.com/pdfs/HearCatalog.pdf) is placed on thetympanic membrane of an ear of a patient 4. A second electrode 12 isplaced on the patient's earlobe, as a reference point, and a thirdelectrode 14 is connected to the patient's forehead and to the commonpoint of the amplifier. A shield connection 16 is also made to anelectrical isolation shield 18 normally placed around the testing room.The shield 18 is connected to the shield of the amplifier 22. To obtainan auditory ECOG signal a continuous auditory signal is applied to theear, comprising alternating polarity acoustic clicks. However, for avestibular ECOG signal (ie a EVestG signal) the patient 4, as shown inFIG. 2, is placed on a chair 6, such as a recliner lounge chair, thatallows the patient's head to be tilted either voluntarily orinvoluntarily. Tilt chairs have been specifically produced by NeuroKinetics Inc. (http://www.neuro-kinetics.com) that enable a patient tobe tilted and produce a response to this stimulus which is lesscorrupted by muscle artefact. An involuntary head tilt is obtained by anassistant manipulating the chair 6 so as to induce the head tilt withoutany patient neck muscle activity. A typical sequence is 20 seconds in aneutral position, 20 seconds tilted and 20 seconds neutral when tiltedback up. The head tilt is done for approximately the same angle as amaximum voluntary head tilt that could be achieved by the patientthemself. Tilts are back, forward, ipsilateral and contralateral. Thoughless effective and less location specific, it is, however, also possiblefor the ECOG system 2 to produce Sp/Ap plots derived from a responsefrom the combined auditory and vestibular system that is producedwithout any specific stimulus. This is based on recorded spontaneousbackground activity of the auditory and vestibular system. For avoluntary head tilt, to obtain a stimulated response, the patient isasked to sit in the chair upright with their head in the neutralposition for 20 seconds, and then their head tilted forward for 20seconds, back to neutral for 20 seconds, backwards again for 20 seconds,neutral for 20 seconds, ipsilateral to the electrode 10 for 20 seconds,neutral for 20 seconds, contralateral to the electrode 10 for 20 secondsand then neutral for 20 seconds.

The neural response produced on electrodes 10 to 14 is continuouslyrecorded by the ECOG system 2. The neural response signal for each tiltis a time domain voltage signal having multiple frequency components.The main components of interest are up to 22,500 Hz, and accordingly thesampling rate used by the system 2 is chosen to be 44.1 kHz. With thisrate the Sp peak (depending on the signal to noise ratio (S/N)) is onlya few samples wide. The signal is characterised by distinct regions intime: (i) a background region comprising primarily background ambientnoise; (ii) an onset region for the start of tilt (approximately 0-5seconds after tilt onset) which includes the response of the semicircular canals and otolith organs; (iii) a transient region for theremainder of the tilt (approximately 5-10 seconds after tilt onset)which includes the response of the semi circular canals (decaying) andotolith organ; and (iv) a steady state region (approximately 10-20seconds after tilt onset) which includes essentially the response of theotolith organs. An example of a recorded response signal for aninvoluntary tilt is shown in FIG. 3, and the elements of the signal aredescribed in the table below

Tilt Segment Time (sec) Background  5-20 Onset 20-25 Transient 20-30Steady state 30-40 Onset (tilting back up) 40-45 Transient (tilting backup) 40-50 Steady state (tilting back up) 50-60

The computer system 20 of the ECOG system 2 includes the amplifier 22and a communications module 24 for handling the output of the amplifier22 and then storing the response as a voltage signal over time as a wavefile using a computer program such as Adobe Audition(http://www.pacific.adobe.com/products/audition/main.html) provided by acapture module 26. The amplifier 22 includes a CED 1902 isolatedpre-amplifier and a CED Power 1401 analogue to a digital converter(ADC). Both the CED 1902 and CED 1401 ADC are produced by CambridgeElectronic Design Limited (http://www.ced.co.uk). The CED 1401 ADC hasan excellent low frequency (less than a few Hz) response. The computersystem 20 has further software modules, including an analysis module 28and a display module 30. The analysis module 28 includes computerprogram code (eg. MATLAB® code, http://www.mathworks.com) responsiblefor performing neural event extraction processes, as shown in FIGS. 4and 13, in conjunction with the other software modules. The analysismodule 28 also executes a number of different filters used to filter theresponse signal samples, as discussed below. The graphics display module30 generates a user interface 32 for an operator of the ECOG system 2 toprovide input controls so that the operator can control the neural eventextraction process, and to generate displays of neural event data, suchas the Sp/Ap plots shown in FIGS. 5 to 10. The computer program code ofthe software modules 24 to 30 of the computer system 20 are run on anoperating system 34, such as Microsoft Windows or Linux, and thehardware used may include the amplifier 22 and a standard personalcomputer 20, such as that produced by IBM Corporation(http://www.ibm.com). ECOG recording systems are produced by Bio-LogicSystems Corp (http://www.blsc.com/hearing/). Whilst the neural eventextraction process may be performed under the control of the software ofthe modules 24 to 34, it will be understood by a skilled addressee thatsteps of the process can be performed by dedicated hardware circuits,such as ASICs and FPGAs, and also performed by components or modulesdistributed across a computer communications network, such as theInternet.

The neural event extraction process uses known temporal and frequencycharacteristics of an Sp/Ap plot to try to accurately locate an evokedresponse from the patient. Basically only a rough shape of the plot andthe expected latency between the points of interest is known. Latencybetween the points corresponds to a frequency range of interest.Accordingly, the Sp/Ap plot is known to exhibit a large phase changeacross a frequency range of interest at points on the Sp/Ap plot, inparticular, the Sp, Ap, onset of Sp, offset of Ap and beginning of Sp2points. The neural event extraction process operates to produce arepresentative data stream that can be used to determine neural eventsoccurring in the right time frame and with appropriate latency that canbe considered to constitute characteristic parts of an evoked response.The same principle can also be applied to other AERs, as discussedbelow.

The neural event extraction process, as shown in FIG. 4, involvesrecording the voltage response signal output by the amplifier 22 inresponse to a head tilt (step 302). Where necessary a 50 or 60 Hz mainspower notch filter is applied to the recording in the amplifier stage toremove power frequency harmonics. The response signal from the amplifier22 may also be high pass filtered (for example by a 120 Hz 1 poleButterworth filter) to enable the extraction process to generateimproved Sp/Ap peak plots (eg as shown in FIG. 11) at step 350. If thevery low frequency data is retained, ie <10 Hz, then this can be used toplot (at step 350) discriminate “dc” magnitude threshold shifts prior toa neural event. These threshold shifts are shown in FIG. 12 and relateto the onset region (largest shift and therefore at the bottom of FIG.12), the transient region (next largest shift) and the steady stateregion (lowest shift and at top). Examination of this very low frequencydata, and in particular the magnitude shifts, can be used to aid thediagnosis of central nervous system disorders, as described below, andin particular illustrate more cortical influences on the vestibularsystem. Absence or enhancement of the shifts tend to indicate adisorder.

The recorded response signal is decomposed in both magnitude and phaseusing a complex Morlet wavelet (step 304) according to the definition ofthe wavelet provided in equation (1) below, where t represents time,F_(b) represents the bandwidth factor and F_(c) represents the centrefrequency of each scale. Other wavelets can be used, but the Morlet isused for its excellent time frequency localisation properties. Theneural response signal x(t) is convolved with each wavelet.

$\begin{matrix}{{\psi \mspace{14mu} {{Morlet}(t)}} = {\frac{1}{\sqrt{2\pi \; F_{b}}}e^{{j\; 2\; \pi \; F_{c}t} - \frac{t^{2}}{2F_{b}}}}} & (1)\end{matrix}$

To directly measure the vestibular system, seven scales are selected torepresent wavelets with centre frequencies of 12000 Hz, 6000 Hz, 3000Hz, 1500 Hz, 1200 Hz, 900 Hz and 600 Hz. Different frequencies can beused provided they span the frequency range of interest and are matchedto appropriate bandwidth factors, as discussed below. The waveletsextend across the spectrum of interest of a normal vestibular Sp/Apresponse signal, and also include sufficient higher frequency componentsso that the peaks in the waveform can be well localised in time.Importantly, the bandwidth factor is set to less than 1, being 0.1 forthe scales representing 1500 to 600 Hz and 0.4 for all remainingfrequencies. Using a bandwidth factor that is so low allows for bettertime localisation at lower frequencies, at the cost of a frequencybandwidth spread, which is particularly advantageous for locating anddetermining neural events represented by the response signal. Magnitudeand phase data is produced for each scale representing coefficients ofthe wavelets.

The phase data for each scale is unwrapped and differentiated (306)using the “unwrap” and “diff” functions of MATLAB. Any DC offset isremoved, and the result is normalised for each scale to place it in arange from −1 to +1. This produces therefore normalised, zero averagedata providing a rate of phase change measurement for the responsesignal.

A first derivative of the phase change data (actually a derivative of aderivative) is obtained for each scale (308), and normalised in order todetermine local maxima/minima rates of phase change (320). To eliminateany false peaks, very small maxima/minima are removed at a threshold of1% of the mean absolute value of the first derivative (322). Allpositive slopes from the first derivative (308) are set to 1, negativeslopes to −1 and then a second derivative of the phase change data isobtained (310) to produce −2 and +2 step values. Each scale is thenprocessed to look for resulting values of −2 and +2 which representpoints of inflexion for the determined maxima and minima (320). Forthese particular loci, a value of 1 is stored for all scales. For thelow frequency scale, ie 600 Hz, the actual times for both the positiveand negative peaks are also stored for analysis to further isolate thedriven responses as discussed below.

The original response signal in the time domain (312) is also processedto detect points which may be points of maximum phase change forcomparative analysis with the extracted phase peaks from the waveletanalysis. Firstly the mean and maximum of the original signal isdetermined. The signal is then adjusted to have a zero mean. Using thissignal, the process locates and stores all points where the signal isgreater than the mean minus 0.1 of the maximum in order to identifyregions where an Ap point is least likely (positive deviations aboveaxis) and to exclude in later derivatives maxima as a consequence ofnoise. The slope of the original response is obtained by taking thederivative of the original response, and then also determining theabsolute mean of the slope. For the result obtained, all datarepresenting a slope of less than 10% of the absolute mean slope is setto 0. A derivative is then obtained of this slope threshold data (314)which is used to define the local maxima/minima of the slope (316).Similarly, the absolute mean of this result is also obtained and athreshold of 10% of the mean used to exclude minor maxima/minima (step318). All positive slopes of the original response are set to 1 and thenegative slopes are set to −1, and then a second derivative obtained(314). From this derivative each scale is examined to find values of −2and +2, representing points of inflexion. The position of these loci arestored for the positive and negative peaks.

For each scale, if there is a positive peak, ie a maximum, determinedfrom the first slope derivative, then for any peaks corresponding tothese times (+1 or −1) these are set to 0 in any scale in which theyappear in order to initially selectively look for the Ap point whichwill be a minima. The same is also done for points that were previouslydeemed unlikely regions for an Ap point found during the originalprocessing of the time domain response signal (312). The times of thepeaks determined during processing of the phase data, and thatdetermined during processing of the time domain signal, are compared(step 324). Because of scale dependant phase shifts inherent indetecting each wavelet scales phase maxima, the wavelet scale maxima arecompared with those detected in the time domain and shifted tocorrespond to a magnitude minima in the time domain. Thus potential Aploci (326) are determined.

The loci times for the low frequency scale, scale 7 representing 600 Hz,are searched to attempt to locate the Sp point, as it is most likelythat the preceding steps have determined the Ap point, due to the sizeof the signal and the difficulty of normally locating the Sp point. Thissearch is undertaken over a range of normally 0.1 to 0.9 ms (dependingon the noise level; for example the lower limit of 0.1 may be increased,say to 0.5) before the potential Ap point looking for +2 values (i.e.negative peaks) in this range. If the value of the original responsesignal at the potential Sp point is greater than 0.9 of the potential Appoint (a negative value), then both the Ap loci and the potential Sploci are stored. If an Sp point is located 0.1 to 0.9 ms before the Appoint, then the 600 Hz scale loci time for the Ap point and the timedomain minima, proximal to that Ap point, are checked to determinewhether they are at the same point in time. If this is not the case,then the scale loci is reset to match the time domain loci to take intoaccount any limitations in time localisation properties associated withthe wavelet decompositions. For verification, similar locationprocedures for the Sp point can be performed on the other scales, butthis is not needed in all cases.

All of the scales are then processed (step 330) to look for maximaacross the scales and link them to form a chain across as small a timeband as possible. This allows false Aps associated with all of thescales to be eliminated. The analysis module 28 is able to use a “Chainmaximum-eliminate “false” maxima” routine of MATLAB® to perform thisstep.

As described below, a Sp/Ap plot is formed by processing the time domainsignal (or averaging the time domain signals obtained) centred on thelocal maxima determined previously. Following the Sp/Ap plot formationprocess, maxima/minima values are further determined to establish thebaseline (ie the average level before the evoked response, as shown inFIG. 1) necessary to calculate the Sp/Ap.

Using firstly the +2 values, and then the −2 values if no +2 values arefound, for the points of inflexion determined from the phase data, theloci is searched in the range allocated to the Sp previously determined(typically 0.5 to 0.9 ms before Ap). For each Ap, remaining after theelimination process (330) the Sp times are found and averaged to recordan Sp.

The baseline is found (340) by starting at the Sp point −0.2 to −0.6 ins(based on average Sp/Ap shape), and again beginning with the +2 pointinflexion values, and then −2 point inflexion values (if necessary) ofthe phase data in a time range initially allocated to the baseline. Foreach Sp plus offset, the potential baseline times are found and averagedto record an initial baseline time. If the baseline time does not meet abaseline check, then the process is repeated starting with the newbaseline time estimate. This process is repeated until a baseline checkis met, which may be whether a baseline is within a predetermined timerange from the Ap and Sp. The average magnitude at the determined timeis used. Alternatively, the baseline can be determined as being the meanof the first 300 samples of the Sp/Ap plot.

Sp2 is found (330) by also using firstly the +2 values for the points ofinflexion of the phase data, and then if there a no +2 values using the−2 values, and searching for loci in the range allocated (initially 1.3ms after the Ap). For each Ap plus offset, the Sp2 times are determinedand then averaged to record an Sp2 time. The average magnitude at thedetermined time is used.

An artefact, being a spike of about 3 samples wide, is produced at thetip of Ap due to the selection of local minima in the time domain basedon scale determined loci proximal thereto. The samples corresponding tothe spike (which may be up to 5 samples) should be removed, and this isdone (342) by using the values of the points on either side of the spiketo interpolate values into the removed sample positions. A filter, suchas a 15 point moving average filter, can then be applied after removalto smooth the response.

Based on the Sp, Sp2 and Ap neural events determined, the ratios Sp/Apand Sp2/Ap are calculated and displayed with the plot of the vestibularresponse (350). The plot is generated by the display module 30 using thetimes/loci of the maxima and minima determined by the neural eventextraction process.

In summary, the neural event extraction process uses a complex timefrequency approach with a variable bandwidth factor to determine thepoints where maximum/minimum phase changes occur across a range offrequencies characteristic of neural events associated with an Sp/Applot. The maximum/minimum phase change is used to establish the Ap, Sp,Sp2 and baseline points. Being able to determine these points enableselimination of other phase change events that are not related to anSp/Ap plot, such as those produced by background noise. Also,maximum/minimum phase change points are correlated with events in thetime domain to reduce time localisation error inherent in the use of thefrequency domain representation provided by the wavelet analysis.

FIG. 5 shows an example of a display produced by the ECOG system 2following analysis of a 1 second region of a steady state response (14.4seconds after head tilt onset) to a voluntary backwards head tilt(patient's eyes open). The Sp/Ap ratio is determined to be 22.6% by theanalysis module. The horizontal scale is 1 ms, equivalent to 44.1samples of the evoked response signal. FIG. 9 shows a similar displayproduced following analysis of a 10 second region of a steady stateresponse (10 seconds after head tilt onset) where the Sp/Ap ratio isdetermined to be 28%.

FIGS. 6, 7 and 8 also show Sp/Ap plots produced using the ECOG system 2.The plots are for a non voluntary movement on a tilt chair. FIG. 6 is aplot for the onset region, FIG. 7 is a plot for the transient region andFIG. 8 is a plot for the steady state region. All the plots have abaseline, Ap and Sp (and Sp2 seen normally only with tone stimulusresponses and also for the onset period or component of excitatory tiltresponses) point marks that can be determined by the neural eventextraction process of the analysis module 28. FIG. 10 also shows Sp/Applots produced for the onset region (dark), steady state region (light)and for the transient region (medium). In this Figure, the Sp and Ap isshown as only that determined for the steady state response.

The system 2 as described is able to perform an accurate analysis of aresponse from the vestibule that not only can be used for the detectionof Meniere's disease, but can also be used for diagnosis of Parkinson'sdisease and depression as discussed below. Also other neural events canbe sought and determined, such as those produced by other auditorynuclei. The system 2 can be configured to obtain other AERs and theanalysis module 28 used to accurately process the AER obtained, such asan ABR.

Latency considerations relevant to the Auditory Brainstem Response (ABR)allow for the separation then generation of Sp/Ap like waveforms fromeach main nuclei. Responses from subnuclei like the Medial Nucleus ofthe Trapeziod Body, Lateral Superior olive and Medial superior olive ofthe superior olivary complex are also separable. Responses could also beobtained from the visual pathway and its nuclei, indeed most evokedresponse pathways.

For the ABR, the system 2 is adjusted so the analysis module 28 executesan ABR process, as shown in FIG. 13, and the electrodes 10 and 12 arerearranged to obtain an ABR response, instead of an ECOG response. Inparticular, the patient 4, remains at rest, and the electrodes 10 and 12are used as surface electrodes, with one being placed on each mastoid,and the additional electrode 14 used on the forehead. The patient's legis again connected to the shield 18. The stimulus produced by thecomputer system 20 is an audible click (100 us) or tone pip (5 ms), eg80 dB SPL (sound pressure level), repeated about 300-1000 times. Eachstimulus is 200 ms apart. The first 10 ms post stimulus is recorded. TheABR process, as shown in FIG. 13, is primarily the same as the neuralevent process described above with reference to FIG. 4, except for thefollowing:

-   (i) The first stage of the process (302) performs segmentation by    recording the 10 ms of interest from the 200 ms of each response    signal received. The recorded 10 ms time domain signal is then    filtered using a 500 Hz-4 kHz bandpass 6 pole Butterworth filter.-   (ii) The wavelet scales used in the step 304 have the same bandwidth    factors, except a very small bandwidth factor of 0.05 is used for    the lowest frequency scale, 600 Hz.-   (iii) Additional processing (802) is performed after step 330 to    determine the Ap point marks corresponding to each of the subnuclei    of interest. This is done on the basis of the latencies of the Aps    in comparison with the time domain data in order to construct an    Sp/Ap plot for the nuclei and subnuclei of interest, eg 3.2 ms to    4.4 ms for peak III of an ABR.

FIG. 14 is a display produced of a plot showing the neural eventsdetected by the system 2 from 25 ABR stimulus recordings, with theneural events corresponding to peaks II to V of an ABR delineated. Thedata for each of the detected neural events, at times associated withthe events, can be averaged to produce Sp/Ap plots for the nucleus ofinterest. FIG. 15 illustrates the timing, ie the latency, of thedifferent ABR components for the different nuclei and subnuclei, whichinclude the auditory nerve (AN), the dorsal cochlea nucleus (DCN),ventral cochlea nucleus (VCN), medial nucleus of trapezoid body (MNTB),lateral superior olive (LSO), medial superior olive (MSO), laterallemniscus (LL), central nucleus of inferior colliculus (ICC),pericentral nucleus of inferior colliculus (ICP), external nucleus ofinferior colliculus (ICX) and medial geniculate body (MGB). Theresponses from the nuclei and subnuclei are separable into differentevents as shown in FIG. 14. Using a tone instead of a click enables aresponse to be evoked from the lamina in the nucleus of interest. Theneural event detected using a click is a response from the entiretonotopic region of the nucleus. However by using a tone only, onelamina or layer of the nucleus is excited allowing for the localisationwithin the nucleus of any departures from a normal response.

A further application of the ECOG system 2 is detecting the degenerationof cells in the Basal Ganglia (eg Substantia Nigra in Parkinson'sDisease) by accurately detecting the 70-300 Hz inter-event intervals(time-frequency representations) and changes in the neural Sp/Apresponse characteristics (including Ap width, Sp peak height, etc)consequent to changes in the Basal Ganglia and other connectedstructures observed in the vestibular response and believed to bemodulated by Basal Ganglia outputs via the reticular formation to thevestibular nuclei. This is particularly useful for quantitativelymeasuring the efficacy of therapies and drugs to treat, as well as forthe early detection of, Parkinson's disease. FIG. 16 shows two Sp/Applots produced by the system 2 for a Parkinsons patient, one where thepatient is without medication (upper), and another where the patient iswith levodopa medication (lower with a deliberate offset for clarity).The effect of the medication is indicated by the Ap width, ie the TAPmeasurement, the Sp magnitude change and the general change in the Sp/Applots. The TAP is a time measure from the minima peak (“notch”) beforethe Sp peak horizontally to the upward arm of the Ap, as shown in FIG.16. Alternatively, a different TAP measure could be the internal widthof the Ap horizontally at the Sp notch vertical level used in thepreceding definition.

Another application is detecting the decrease or increase in activity ofcells in the Basal Ganglia (eg Thalmus in depression) co-incident withchanges in depressive state by again accurately detecting changes in the70-300 Hz inter-event intervals (time-frequency representations) andchanges in the neural Sp/Ap response characteristics (including Apwidth, Sp peak height, etc) consequent to changes in the Basal Gangliaand other connected structures observed in the vestibular response andbelieved to be modulated by Basal Ganglia outputs via the reticularformation to the vestibular nuclei. This is particularly useful forquantitatively measuring the efficacy of therapies and drugs to treatdepression, as well as the detection of depression (particularly inintellectually disabled and those with limited communication skills).FIG. 17 shows two Sp/Ap plots produced by the system 2 for a patientsuffering depression. One plot is before the patient is medicated (lowerand light), and the second plot has been taken three hours after thepatient has been medicated with SSRIs (Selective Serotonum UptakeInhibitors) (upper and dark). Again, the effect of the medication isindicated especially by the Ap width, ie the TAP measurement marker.

FIG. 18 shows an Sp/Ap plot produced by the system for a Meniere'spatient with (lower) and without medication (upper), this again showsthe stark differences between the Sp/Ap plots, and the Ap width measure,TAP. The medication used was AVIL™ (43.5 mg). FIG. 19 shows Sp/Ap plotscomparing a Meniere's patient with symptoms on the left side (upper) butnot on the right side (lower).

The analysis module 28 of the system 2 is able to produce a series ofmarkers to discriminate between patients that have, or to determinewhether they have, a disorder, such as a central nervous system (CNS)disorder, and in particular whether they are depressed, sufferingMeniere's disease, or suffering Parkinson's disease. The markers include(i) the Sp/Ap point marks, (ii) the TAP measurement, being the time andduration of Ap (plus the Sp peak depending on the TAP period definitionused), and (iii) a HF/LF ratio being the ratio of the high frequencyenergy to the low frequency energy of the average wavelet coefficientsof the scales, as shown in FIG. 25. The HF/LF ratio is a ratio for theresponse signal of the high frequency and low frequency areas beneaththe plot of the averaged wavelet coefficients against frequency for therespective ranges 50 to 500 Hz and 2 to 28 Hz, as shown in FIG. 25.FIGS. 20 to 24 show a variety of TAP measurements obtained for differentpatients, and illustrate how they can be discriminated. FIG. 26 showshow the HF/LF ratio can be used as a discriminating marker. Othermarkers are provided by analysis of scales for the 70 to 300 Hz range todetermine alterations to the response signal and Sp/Ap plots due tomodulation by the Basal Ganglia components. The alterations may be thepresence or absence of peaks or distribution changes for time againstfrequency representations for this range. Peaks within this range,particularly proximal the ranges 70-90 Hz, 110-150 Hz and 200-300 Hz,may indicate activity of the Basal Ganglia components. If those markersare used, additional scales are used by the neural event process for the70 to 300 Hz range.

To assist diagnosis, the magnitude, phase, frequency and time dataextracted by the neural event process can be used to generate threedimensional or four dimensional (with color) plots for responsesobtained from patients.

Many modifications will be apparent to those skilled in the art withoutdeparting from the scope of the present invention as herein describedwith reference to the accompanying drawings.

1.-34. (canceled)
 35. A neural response system, including: electrodesfor connecting to a person to obtain a neural response signal; anamplifier for receiving and producing a sampled form of said signal forprocessing; and an analysis module for decomposing said signal using atleast one wavelet, differentiating phase data of said wavelets and saidresponse signal to determine maxima and minima of said phase data andsaid signal, and processing said maxima and minima to determine peaksrepresenting neural events.
 36. A neural response system as claimed inclaim 35, including a tilt chair for tilting a person to provide astimulus to evoke said response signal.
 37. A neural response system asclaimed in claim 36, wherein said electrodes include an ECOG electrodeplaced adjacent a tympanic membrane of the person.
 38. A neural responsesystem as claimed in claim 35, wherein said decomposing is performedusing wavelets with a bandwidth factor less than one.
 39. A neuralresponse as claimed in claim 38, wherein said wavelets have centrefrequencies across a frequency spectrum of said signal.
 40. A neuralresponse system as claimed in claim 39, wherein said differentiatingincludes generating a number of derivatives of said phase data producedby said decomposing, and said maxima and minima of said phase datarepresent rate of change of phase of scales of said wavelets.
 41. Aneural response system as claimed in claim 40, wherein saiddifferentiating includes generating a number of derivatives of saidresponse signal to produce said maxima and minima of said signal, andsaid processing includes correlating said maxima and minima of saidphase data and said signal based on time data for said maxima andminima.
 42. A neural response system as claimed in claim 41, whereinsaid processing includes eliminating false peaks by applying thresholddata to said maxima and minima.
 43. A neural response system as claimedin claim 42, wherein said correlating includes linking said maximaacross said scales and across a time band to eliminate false peaks. 44.A neural response system as claimed in claim 43, wherein said processingincludes applying predetermined latency ranges for said peaks to saidmaxima and minima to determine said peaks.
 45. A neural response systemas claimed in claim 44, wherein said receiving includes filtering andsampling said response signal for said decomposing, differentiating andprocessing.
 46. A neural response system as claimed in claim 38, whereinsaid bandwidth factor is between 0.05 and 0.4.
 47. A neural responsesystem as claimed in claim 46, wherein said bandwidth factor is 0.1 forlow frequency scales and 0.4 for other scales.
 48. A neural responsesystem as claimed in claim 46, wherein said bandwidth factor is 0.05 forthe lowest frequency scale.
 49. A neural response system as claimed inclaim 45, wherein said analysis module filters said response signal toremove at least one artefact.
 50. A neural response as claimed in claim35, wherein said neural events are represented by Sp and Ap markerscorresponding to said peaks.
 51. A neural response system as claimed inclaim 35, wherein said maxima and minima of said phase data and saidsignal are compared to generate an Sp/Ap plot.
 52. A neural responsesystem as claimed in claim 35, wherein said neural response signal isproduced in response to a head tilt of a person.
 53. A neural responsesystem as claimed in claim 35, wherein said neural response is producedin response to an auditory stimulus of a person.
 54. A neural responsesystem as claimed in claim 52, wherein said maxima and minima are usedto generate data indicating whether said person has a central nervoussystem disorder.
 55. A neural response system as claimed in claim 52,wherein said maxima and minima are used to generate data indicating aresponse by said person to medication for a central nervous systemdisorder.
 56. A neural response system as claimed in claim 52, whereinsaid maxima and minima are used to generate data indicating whether saidperson has Meniere's disease.
 57. A neural response system as claimed inclaim 52, wherein said maxima and minima are used to generate dataindicating a response by said person to medication for Meniere'sdisease.
 58. A neural response system as claimed in claim 52, whereinsaid maxima and minima are used to generate data indicating whether saidperson has Parkinson's disease.
 59. A neural response as claimed inclaim 52, wherein said maxima and minima are used to generate dataindicating a response by said person to medication for Parkinson'sdisease.
 60. A neural response system as claimed in claim 52, whereinsaid maxima and minima are used to generate data indicating whether saidperson has depression.
 61. A neural response system as claimed in claim52, wherein said maxima and minima are used to generate data indicatinga response by said person to medication for depression.
 62. A neuralresponse system as claimed in claim 35, wherein said maxima and minimarepresent a response obtained direct from the vestibular system of aperson.
 63. A neural response system as claimed in claim 35, whereinsaid maxima and minima represent components of the vestibular system.64. A neural response system as claimed in claim 35, wherein said maximaand minima represent a response obtained direct from auditory nuclei andsubnuclei of the ear of a person. 65.-87. (canceled)